homeopathy
The Indian government's Ministry of AYUSH, which promotes alternative medicine systems in the country, released a health advisory on January 29 that advocates the use of homeopathy and traditional remedies, such as Indian systems of medicine, to ward off infections of the newly circulating 2019-nCoV coronavirus. This includes the use of a homeopathic preparation called Arsenicum album 30C and two drops of sesame oil in each nostril each morning for prevention, and Unani medicines (treatments based on the teachings of Hippocrates and Galen) to mitigate symptoms of coronavirus infection. While AYUSH cites centuries of practitioners' experiences with these products as evidence behind its advice, the media and the scientific community criticized the guidance as being counterproductive in dealing with a serious health emergency.

"It is profoundly irresponsible of the Ministry of AYUSH to endorse homeopathy as this entirely undermines public understanding of science and medicine, and elevates pseudoscience with potentially dangerous consequences," says David Robert Grimes, an Irish science writer who has published research showing homeopathy to be ineffective, in an email to The Scientist. Grimes has argued that the proposed mechanisms of homeopathy are implausible when analyzed from a physical and chemical perspective, and says that it is not surprising, therefore, that the biological effects of homeopathy cannot be measured in large-scale clinical trials.

To date, more than 31,000 people in more than two dozen countries have been infected with 2019-nCoV, including three confirmed cases in India. According to the World Health Organization, there is no intervention yet identified that can treat the virus, although a number of studies are underway to find therapeutics and develop a vaccine.

Until then, the US Centers for Disease Control and Prevention says the only way to prevent infection is to avoid contact with the virus and people who are sick, to wash your hands, and not touch your face. But the Central Council for Research In Homeopathy (CCRH) of the Ministry of AYUSH claims that there are other preventive options.

Anil Khurana, who heads the CCRH, tells The Scientist that Arsenicum album 30C, a homeopathic solution prepared by diluting aqueous arsenic trioxide until little or no arsenic remains that is used in respiratory disorders and has been in widespread use for more than 220 years with a good safety record, was found to be an effective prophylactic during the swine flu epidemic in India in 2009. A study conducted by Robert Mathie of the British Homeopathic Association and his group, in collaboration with the CCRH, reported in Homeopathy that of the various homeopathic medicines given to patients with swine flu symptoms, Arsenicum album was most successful in reducing fever, cough, runny nose, sore throat, and headache. There was no control arm. In another, placebo-controlled trial conducted by the CCRH, homeopathic medicines were also found to reduce flu-like symptoms.

These results led the CCRH to look to possible homeopathic interventions against the new coronavirus. Before any 2019-nCoV infections had turned up in India, scientists at CCRH collated the clinical features of a recent cluster of cases in China that was published in The Lancet on January 24, which they fed into a tool called the homeopathic repertory. The repertory is a database of historic texts on homeopathy, and when practitioners enter symptoms, the tool fetches the texts' recommendations on which medicine needs to be given. "Every time we repertorize a patient, we are pretty much consulting all these generations of homeopaths that have contributed to this database," says Bernado Merizalde, a homeopathy practitioner at Thomas Jefferson University in Philadelphia and the prime general secretary of Liga Medicorum Homeopathica Internationalis, a homeopathic doctors' association. By matching the clinical features, the repertory found Arsenicum album 30C to be a suitable fit for the current outbreak.

The basic premise of homeopathy is that a medicine that produces a set of symptoms when given to a healthy person under controlled settings can be prescribed in a highly diluted form to a diseased person with those same symptoms, explains Kushal Banerjee, a homeopathic physician based in New Delhi. This is what is known as Similia similibus curentur in homeopathic parlance, a Latin phrase that means "like cures like." Kalyan Banerjee, Kushal's father and a renowned homeopathic practitioner, says that by boosting the immune system of the body, Arsenicum album can potentially reduce the virulence of the coronavirus, thereby tempering disease intensity.

"We don't claim 100 percent protection with Arsenicum album. Just taking the medicine will not work," says Khurana. "All general measures for airborne infections have to be taken." He further adds that if people get infected, they should promptly seek medical care.

Such caveats do not assuage the concerns of homeopathy's detractors, who say there is no rigorous scientific evidence to indicate homeopathic remedies can prevent coronavirus infection or mitigate symptoms. "The claim of some homeopaths that homeopathic remedies are effective in treating or preventing coronavirus infections is not based on any evidence at all," Edzard Ernst, an emeritus professor at the University of Exeter in the UK and a critic of homeopathy, tells The Scientist in an email. Ernst points to a study that found no difference between Arsenicum album and a placebo in preventing fever after vaccination. Other studies in which homeopathy was found to be ineffective include one on acute respiratory tract infections, another on middle ear infections, and yet another on influenza-like illness.

"Using homeopathy as an alternative therapy risks forfeiting effective causative or symptomatic treatments or — if such treatments are not available — creating a false sense of security," says Ernst. "In any case, it would be a waste of resources."

Even among proponents of homeopathy, there is disagreement about the best way to prevent the coronavirus. Mitchell Fleisher, the second vice president of the American Institute of Homeopathy, says that the Lancet article that scientists at CCRH used to come up with their advice does not provide enough information on symptoms to make an accurate homeopathic prescription.

He says that perhaps the best way to validate the therapeutic value of homeopathy would be to perform a comparative clinical outcome study of acute coronaviral infection by giving individualized homeopathic medicines to one experimental group and allopathic medicines to another, with a minimum of 250 patients in each group. "A careful and honest, statistical analysis of the study results will speak the scientific truth," he says.

Countering Fleisher's proposal, Grimes says that this is completely unethical. "Homeopathy has no plausible mechanism of action, and it is downright irresponsible to suggest it in a trial for a serious potential pandemic. Large scale studies of homeopathy have clearly shown over decades the same result — that it simply does not work," he says.

Alakananda Dasgupta is a freelance science journalist and physician based in New Delhi, India. Follow her on Twitter @AlakanandaDasg1or email her at alakanandadasgupta@gmail.com.